A few warnings & questions about supplements
 

Supplements are a great way to help our brains recover from the trauma, and to also feel better while in the process of recovery.

I feel there are some mistakes people do with supplements that are sometimes potentially dangerous.

Here are a few warnings you should know about supplements:

1. Vitamin B6 is an important vitamin, since it is mainly required for the synthesis of neurotransmitters (it is a cofactor). High doses (especially 100mg+) of B6 are suspected of being neurotoxic, causing neuropathy with extended use. The nerve damage from overdoses of B6 can be either temporary or permanent. The recommended daily intake is 1-2mg, but most supplements contain 50mg or more, at least 25 times the recommended daily intake (especially in B-50 Complex supplements). B6 toxicity cannot happen when it is supplemented from natural sources, because it is easily degraded by the body when no more is needed. Therefore, if you want to take B6, try to find a supplement with doses as close as possible to 1-2mg of it.

2. 5-HTP is a supplement sold for improving anxiety and sleep issues. It is metabolized to Serotonin in the body and in the brain (it can cross the blood-brain-barrier). The problem here is that serotonin is cardiotoxic, causing damage to the heart valve (by activating 5HT-2B receptors on it), which ultimately requires an heart valve replacement surgery. Rats treated with long-term, high doses of serotonin show heart valve damage. There is no solid evidence for this kind of toxicity happening in humans, but it is heavily suspected that it's possible. Therefore, if you take 5-HTP, you should take it with an AAAD inhibitor - AAAD is the enzyme that converts 5-HTP to serotonin outside of the brain. An inhibition of this enzyme will cause the 5-HTP to be metabolized ONLY inside the brain, leaving the heart unaffected. A good inhibitor of this enzyme is EGCG, which is found in green tea and can be bought as a supplement itself. Also, make sure not to take too high doses of 5-HTP if you do.

Now, I have a few questions to people who already take supplements here:

1. Is Magnesium potentially neurotoxic? Antagonists of the NMDA receptor (such as Ketamine and Dextromethorphan) produce Olney's Lesions, a type of brain damage, when they are given to rats (NMDA receptors bind Glutamate, which excites the neuron and generates an action potential). Magnesium is a non-competitive antagonist of the NMDA receptor. If NMDA receptor antagonists produce brain damage, and Magnesium is a non-competitive antagonist of this receptor, can it produce brain damage as well? Can Magnesium help with nerve regeneration and reconnection in the brain after an injury?

2. Why is it recommended in the supplements thread to take Magnesium with Calcium? From what I've understood, Magnesium and Calcium are antagonists of each other; Magnesium tends to be inhibitory, while Calcium tends to be excitatory in nerve tissue (Calcium is required for the generation of action potential by Glutamate). From this reason, wouldn't it mean that taking a supplement that combines them will cause them to cancel some of the effects of each other? And can Calcium specifically help with recovery?

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My personal planned supplement stack (all of them are in pill/capsule/tablet/softgel form unless stated otherwise):

Omega 3 - 500mg EPA/250mg DHA/day
Vitamin Methyl-B12 - 1500mcg/day
Vitamin D3 - 5000IU/day
Magnesium Citrate - 200-500mg/day

Melatonin - 0.3mg (only taken at night, never during the day)

I am already taking 1mg of Melatonin right now, as a matter of fact, and it is helpful for sleep. I would like to reduce the dosage to 0.3mg, however, since I've heard lower doses work better.

I know many other supplements are recommended in the thread - I've chosen these because they seem the most important to me for recovery, dealing with ADHD and OCD. I'm quitting Adderall entirely next week, and would only take supplements for my ADHD (this decision is final - the side effects of Adderall just got too bad for me to handle).

What do you think? Are the dosages OK?

What side effects did you experience with Adderall that have made you decide to quit?

Personally I think looking at what we eat should come before deciding on a vitamin supplement regime. Eating fresh fruit and vegetables, cutting back on red meat, caffeine, alcohol, processed foods and especially sugar are likely to be more beneficial in the long term.

I should have said, take calcium with magnesium. Calcium is important but problematic without adequate magnesium. They are often sold together.

I have always said to take the minimum amount of 5-HTP to get a benefit. More is not better. If 50 mgs does not help, try 100.

SSRI's can cause high serotonin and other problems. For people who are struggling to have enough serotonin, rather than taking an SSRI, take a small amount of 5-HTP (or L-Tryptophan) and slowly dose up to get benefit. I do very well with 100 mgs. It took high doses of an SSRI to get the same effect.

From ncbi:

Vitamin B6 (pyridoxine) causes neuropathy at intakes of 1000 mg per day or more, which is about 800 times the daily intake from foods. There have also been occasional reports of toxicity at intakes of 100-300 mg per day.

50 mgs is rarely a problem. My doctor recommended more than 50 mgs.

The recommended daily intake of 1-2 mgs is to prevent B-6 deficiency, not to prevent B-6 toxicity. The report linked has cited many maximum doses. 500 mgs or 8 mgs/kg is considered the maximum safe level to avoid a risk of B-6 pathologies. 100 mgs showed a non-statistical difference in some subtle neurological functions.

But, more importantly, the full range of B vitamins is important. Folic acid is important to maintain the blood brain barrier and myelin sheath repair. There are other B vitamin balancing factors that I have read but did not focus on because a B-50 Complex addressed these issues without needing to take individual B vitamins other than supplemental B-12.

Thiamine (B-1) is important, Riboflavin (B-2) is also. And niacin. My doc who started me on the regimen actually had me taking additional thiamine and niacin. He gave me weekly B-12 injections until I was 'over the hump' with my symptoms. From then, I took B-12 supplements.

There is increasing evidence that daily, long-term supplementation of vitamins may not only not be beneficial, but may also increase some disease risks. Many nutritionists actively advocate against daily supplementation. Issues with supplementation have only started to become recognised, and over the next decade I suspect more information on this will be synthesised.

Personally I believe the vitamin regime advocated on this site is done too freely. I believe individuals within the first 3 months are likely to derive some benefit from the supplementation, but past that it is too sweeping an assumption to believe that all individuals will benefit from it. Recall, each concussion is unique and what works for one certainly should not be applied universally to all others.

Factor in some known risks, and possibly risks not identified, and I think daily, long-term supplementation should be considered thoroughly.

Eating a healthy, balanced diet is the safest strategy towards wellness.

Eating a balanced diet is very difficult these days.

I'd like to see the evidence of the harmful use of supplements.
Surely the extreme dosing and typical high dose use by body builders, does cause concern. But for the doses suggested here, which are very moderate, that is another thing entirely.

Many people today use acid blocking drugs chronically and this alone creates a malabsorption issue with deriving benefit from the nutrients in foods. Removing acid from the stomach impairs
Calcium, magnesium, iron, zinc, B12, folate and some trace minerals like copper and chromium.

Many people therefore are suffering from hidden low values of B12, folate, magnesium, and Vit D as well. Studies show many do not receive the RDA in magnesium alone, in fact.

Also 10-30% of people have the DNA mutation for methylation systems, which are called MTHFR. This means they need a special B12 and folate (methylcobalamin and methylfolate) in order to make neurotransmitters as well as metabolize food properly, and make normal blood cells. People with this DNA error may just starve in the midst of plenty.

People may be gluten intolerant and have inflamed GI linings and not absorb food nutrients properly. Crohn's disease also
is well known for causing many nutrient deficiencies.

So being the diverse population that we are, we cannot really trust blanket statements like some are making here against using supplements.

People can get tested for many nutrients today. Vit D, B12, B1, and B6 can be tested for, from your doctor.

You have highlighted specific segments of the population, which actually supports my argument. As I had stated, the blanket statement that everyone reading this forum should get on the vitamin sticky regimen is, in my opinion, something that should not be done. Many may not be informed that there are possible negative outcomes associated with long-term vitamin supplementation. In my personal opinion the recommendation to get on the vitamin sticky regimen is misguided and inappropriate. Every concussion is different and individuals may or may not need such supplementation

Recommending someone have blood testing for potential vitamin deficiencies and subsequently developing a vitamin regimen based on the results is completely different. This is both appropriate and possibly relevant for people recovering from an mTBI, and would be done under the care of a physician rather than through and e-based forum suggestion. I think the moderators should carefully consider restricting such endorsements, and I have to admit I'm surprised that this is not only permitted but appealingly endorsed.

On the note of a healthy diet, I do not think this is difficult to achieve if one chooses to do so. We have a globally-enabled food supply with a wealth of choices available usually year-round (e.g. season-based produce are no longer seasonal). However, for a minority of the population they may be faced with challenges (lactose intolerance, vegan, use of proton antagonists, etc) in which other choices are needed. If the diet is unable to meet nutrient needs, then of course supplements are a viable option.

As for the supportive literature, if I feel I'm up to it I'll see if I saved the articles or whether I need to find them again. As an aside, I worked closely with high-level human nutrition researchers who specifically study supplementation and not one of them recommends a daily vitamin. Even supplementation of our staples (milk, bread, grains, etc.) is being evaluated in at risk populations, particularly pregnant women. I suspect the next decade of macro and micro-nutrient research is going to illuminate a number of issues with community and self-administered supplementation, but this is speculative on my behalf and may not be true.

How is eating a balanced diet difficult these days? We have access to more food types from around the world than ever before and healthy organic produce markets in every town. Vitamins are more easily adsorbed via natural foods rather than synthetically. I'm not saying vitamin supplements are bad but taking then without knowing whether you are deficient in them is a hit and miss affair and could be harmful. I think it has to be judged on an individual basis rather than glibly recommending the taking of vitamins for everyone. Before we know it we'll have fluoride in the water supply ;-)

@ MicroMan.... I am ever waiting to see you post links to
valid studies showing your point of view.

The people who tend to end up on NT IMO, as I have been here since 2006, are those who are not healing well, who have been overlooked by numerous doctors who do not check for low B12, accept the horrid side effects from several drug families, (acid blocking drugs, fluoroquininolones, statins) and need interventions of certain nutrients, and have other masked and/or unidentified chronic issues.

Many of them find that replacing certain nutrients (not just taking a daily multivitamin), helps them considerably. The MS forum is one that uses certain things to treat MS...vitamin D, and a few other things. Our PN forum, has several nutrients that help with nerve pain, and we also recommend lowering sugar and white carbs in the diet, and avoidance of foods that may have histamine consequences.

What we discuss here on NT is not the same as Yahoo news items, or other typical internet self help dietary advice.
What I have seen HERE are people suffering from MTHFR mutations who doctors don't even know what that is! People going to 5, 10, yes and even more doctors, who never have tested them for B12 levels.

Here is one example of what is going on in medical offices in this country:
https://www.youtube.com/watch?v=BvEizypoyO0

So I would like to see some links from you. No hurry...
And I'd like to reiterate, that I have not seen anyone on NT suggesting all adults in the US need to take a daily multivitamin. The people who come here are damaged, and need healing help. Check out Dr. Blaylock MD's website. He was recommending certain nutrients to his neurology patients long before this board, or the complementary medical movement. He is now retired but was a neurosurgeon for many years. He follows the research closely and offers a newsletter for a small fee to share his current opinions and insights.
http://www.blaylockreport.com/about_blaylock.html

Rather than dig out individual papers, as I cannot find the ones I had, here is an editorial I recall reading from Annals of Internal Medicine (2013) on vitamin supplementation and measure outcomes linked to controlled and often ranked studies.

Enough is enough: Stop wasting money on vitamin and mineral supplements
http://annals.org/article.aspx?articleid=1789253

Some of the doses, if I recall correctly in the vitamin sticky being recommend to our recommended are highish in nature (note: pretty much every first-time poster is told to follow the vitamin sticky regimen). As the article highlights, danger is in the dose.

Also, I am glad that you are familiar with so many of our community but I think it is likely fair to say that you are not familiar with many of our health dispositions. Assuming that most of the population is the minority for allelic issues, nutrient deficiencies, etc. is not responsible.

The reason why I am speaking up about possible issues linked to vitamin supplementation is that each time I see it being promoted to a member I think of the possible risks that are associated with this regimen. It makes me very uncomfortable, particularly when several of the vitamins being endorsed for daily supplementation have been linked to early mortality and/or cancer.

It is my opinion that people should be presented with information such that they make an informed decision. I think people should be encouraged to work with their physician, endochrinologist, etc. to have tests done so that accurate supplementation, if needed, be used. This may allow some micro/macro-nutrients linked to risks be avoided. This seems sensible and responsible. Having an intensive vitamin regimen associated with high levels of many vitamins and minerals without any risks presented is irresponsible, and, as I said earlier, I'm surprised it is permissible.

Information is always a good thing, and right now the picture of vitamin supplementation here on Neurotalk is not balanced.

microman,

You are grossly misrepresenting the article you linked to. As they say, the devil is in the details. It is a study of multi-vitamin use. Multi-vitamins are dosed based on RDA levels (Recommended Daily Allowance). RDA levels are minimums to avoid malnutrition, not to increase health status. The areas of benefit they are tracking are cognitive decline in well-nourished elderly, recurrence of myocardial infarction, prevention of chronic disease, and similar normal progressions. They do not define what they label as harm other than an implied harm to the wallet.

"With respect to multivitamins, the studies published in this issue and previous trials indicate no substantial health benefit. This evidence, combined with biological considerations, suggests that any effect, either beneficial or harmful, is probably small. As we learned from voluminous trial data on vitamin E, however, clinical trials are not well-suited to identify very small effects, and future trials of multivitamins for chronic disease prevention in well-nourished populations are likely to be futile."

What they are not addressing is how the B vitamins and D-3 help the brain tolerate stress. They are also not addressing the brain compromised/injured population except those with MCI or other dementias.

They are not addressing the population who are deficient for a myriad of reasons.

They are not addressing the anxiety and depression issues that can result from over-stressed brains, especially stress sensitive injured brains, that are reduced in some or even many with proper supplementation.

These arguments have been going on for decades. The pharmaceutical industry has railed against vitamins and supplements claiming poor evidence of efficacy and allude to possible harm but they then promote use of their expensive drugs with TV ads that are mostly all the precautions and risks.

I'd much rather take supplements that my body already knows how to use than take drugs that are foreign and often toxic to my system. The high doses you try to claim are nothing like the mega-nutrition doses used safely by millions of people. There are a few vitamins and supplements that require extra caution like Vit A but 400 iu's of Vit E is well know for its safety. Even 2 grams a day of Vit C is very safe. Some take 10 grams or more to what is called bowel tolerance. Too much Vit C gives one loose stools.

The US federal government requires that iodine be added to table salt and Vit D be added to milk because those are well no deficiencies that impact public health. My brother suffered from Rickets due to Vit D deficiency before Vit D was added to milk.

You are free to choose to not use any vitamins or supplementation. Nobody is going to fault you.

But, it is another issue altogether for you to say we (myself specifically) are being irresponsible.

Regarding the issue of cancer vs vitamins....

http://lpi.oregonstate.edu/feature-s...t-cause-cancer

And Dr. Amen MD has been working with brain damage and ways to heal:

http://www.amenclinics.com/latest-ne...lthy-protocol/

http://www.amenclinics.com/blog/must...ons-seriously/

He appears often on PBS pledge weeks, with his lectures. One of them concentrates on concussion injuries.

The choice to take vitamins /supplements is always up to the individual.
Same for Rx medications and mainstream vs alternative care...

Some key points as I see them, as to whether optimum nutrition can be acquired by foods alone.
*Not everyone is able to, or wants to eat "organic".
*Many people eat a lot of processed, junk foods & beverages and don't read labels or know about basic nutrition.
*Many soils now are depleted of nutrient & micro nutrients.

A compromised body often will benefit from added vitamins /supplements.

************************************************** ********

The information posted on this site is by the members sharing, we all can choose what to take away from our reading and use it or not.

************************************************** ********

Site disclaimer @ bottom of every page.
[The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment
provided by a qualified health care provider. Always consult your doctor before trying anything you read here.]

It doesn't have to be organic, just fresh, and last time I looked basic foods like spinach, kale, broccoli, sweet potato, apples etc were readily available and not expensive - certainly cheaper than eating processed food. If people don't care about what they eat then that's their lookout, they obviously like obesity and diabetes. If any good has come out of this PCS hell it'd that I now have a lot more interest and knowledge about nutrition than I did before and it's common sense that popping a few vits isn't going to make up for living on junk food and pop. In most cases they're probably just a psychological prop.

...btw here's one of many articles I found regarding the taking of supplements.

https://www.sciencebasedmedicine.org...d-cancer-risk/

Again, the devil is in the details.

In that cancer risk study, those taking Vit E or selenium or both increased their risk of cancer by by a combined average of 1.4%.

What is not described is how they defined a prostate cancer diagnosis. Were these prostate cancers the slow growing cancers that have minimal risk to life or the fast growing cancers that can be deadly ? Most men die with prostate cancer but very few die from prostate cancer.

From the report linked:

The initial report of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) found no reduction in risk of prostate cancer with either selenium or vitamin E supplements but a statistically non-significant increase in prostate cancer risk with vitamin E.

Results This report includes 54 464 additional person-years of follow-up and 521 additional cases of prostate cancer since the primary report. Compared with the placebo (referent group) in which 529 men developed prostate cancer, 620 men in the vitamin E group developed prostate cancer (hazard ratio [HR], 1.17; 99% CI, 1.004-1.36, P = .008); as did 575 in the selenium group (HR, 1.09; 99% CI, 0.93-1.27; P = .18), and 555 in the selenium plus vitamin E group (HR, 1.05; 99% CI, 0.89-1.22, P = .46). Compared with placebo, the absolute increase in risk of prostate cancer per 1000 person-years was 1.6 for vitamin E, 0.8 for selenium, and 0.4 for the combination.

mark,

I do not believe I have grossly misrepresented anything, particularly considering the title of this thread ("A few warnings and questions about supplements"). Supplements should not be used unless needed. When they are used, they may be used for long periods and it is reasonable to discuss risks linked to these.

Currently on the forum, there is a propensity by largely you (but not solely) to push the vitamin sticky regime on new and existing members. This makes me uncomfortable and I will not apologise for pointing this out as I do feel it being done irresponsibly. If your supplement works for you, that's great. It does not mean it is universally beneficial and safe for everyone, though.

To provide our community with information linking risks to chronic consumption of nutrient supplements, I felt obligated to post this so everyone can make informed decisions. Note, I am not going to get into citing one paper after another to prove a point(s), though I could if I felt better. This, however, would defeat my original intentions, which were two-fold: i. inform the NT community that blind consumption of micro/macro nutrients may not be beneficial and, more consequently, may pose long-term risks, and ii. that the blind recommendation to adhere to the vitamin sticky regimen that occurs on the NT-PCS forum should not be permitted in the manner it is.

In contrast to the second point, and in my view how this should be approached, new and existing members could be encouraged to eat a healthy diet and, if they’re diet is less-than-ideal, go to their physician and have blood tests done to screen for vitamin and hormone levels (some of our members have done this and I know this has been discussed in several threads). This would permit the synthesis of a supplementation program that is unique and relevant to that individual, rather than one deriving largely from a single person. Further, this would possibly keep costs down and reduce any unnecessary risks that are known at this time or that may be elucidated in future.

There is intense interest in supplements at this time. In line with this and some of the research high-lighted with the editorial I linked, there will be a large quantity of data produced over the next 5-10 years. My guess is that scientists will identify a number of issues linked to long-term supplement consumption; again, this is speculative on my behalf.

Lastly, I like what you said: “You are free to choose to not use any vitamins or supplementation. Nobody is going to fault you.” Fortunately and unfortunately your opinion carries a lot of well-earned weight on NT, so your suggestion to follow this regime is likely followed blindly by many, and that I don’t think is a good thing. Information begets informed choices, and I’m only bringing this to light in the hopes of wellness for everyone. If people want to use supplements, I'm not against that but do so knowing that high doses of vitamins may carry known and unknown risks.

I am going to have to intervene here.

We do not restrict information shared here to only that which is considered to be "scientific". Members are welcome to post about any treatments they choose to, just as members are free to ignore anything they disagree with. This is a patient community where all aspects of treatments, conventional and alternative, are welcome to be discussed. All views are allowed, provided they are shared respectfully and within our guidelines.


There is a disclaimer on every page that states:

For those that choose to take Vitamins & supplements, here is a brand rating site that will help you find best product/brands.
Don't waste money on products that may be low quality or mislabelled.

www.labdoor.com

Microman,

I have never said there is any reason to not eat a healthy diet. The regimen includes comments about avoiding most sugars (especially HFCS), MSG and artificial sweeteners. Non-processed foods are better than processed foods.

Blood work for vitamins and mineral levels and hormones can be helpful but few doctors even pay attention to these issues unless there is a serious lack or imbalance. The range for Vit B-12 goes from 3-400 pgms/mL to 970 pgms/mL. Many with symptoms do better at the 970 pgms/mL level.

The studies mentioned all stated that the benefits of vitamins at usual levels and the risks of vitamins at the usual levels are statistically insignificant. But, they did not study the benefit to those struggling with PCS, PCS related anxiety or PCS related depression. They agree that more research needs to be done to see if there is a statistically relevant correlation.

I have continued to state that the injured brain needs more nutritional support. Many concussion experts include nutritional support beyond healthy diets in their protocols.

Should I not recommend the Vitamins sticky because there is a researched non-statistically relevant risk when many say they have had substantial benefit ?

I ignore when people say, You must eat organic. It's a choice people can make.

Organic increases food costs by 50 to 100% and more. I buy a few items in the organic isle and cringe at the premium for organic. There are plenty of studies that say eating organic is a waste of money except for a few foods that can be washed better or avoided without weakening a diet.

Some have tried the vitamin regimen and decided it was not something they were going to continue. Others have found great value. Some have never tried it at all.

I just learned an additional value to anti-oxidants. One of the problems with injured nerve/brain tissue is an increase in free radicals and the damage they do. Anti-oxidants help to reduce free radicals. An anti-oxidant rich diet can get expensive, especially during the non-growing seasons.

I'll try to remember to say, 'For many, they are not getting enough nutrients for their injured brain so supplementing with vitamins and minerals can be helpful. Or, Many find the Vitamin regimen to be helpful. I do not demand or expect everyone to follow my comments.

Many push mindfulness and other meditation activities and alternative therapies and practices that I disagree with. I personally even consider some to be harmful.

But, people make their own choices.

I hope you will allow those choices to continue without conflict.

I encourage you to post a diet that increases anti-oxidant levels, provides good minerals, good B vitamins (especially B-12) and is affordable and within the food preparation skills and time limits of the average person.

I agree it is up to the individual to decide what they eat or swallow but taking vitamin supplements is no replacement for a crappy diet, I think that's obvious.

Here are a few nutrition & foods information -
http://www.whfoods.com/foodstoc.php
http://www.womansday.com/health-fitn...erfoods-25519/

http://www.brainline.org/content/201...-recovery.html
http://www.eatingwell.com/healthy_co...and_techniques

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225186/


If you want to get optimal nutrition from foods, you may need to do a lot of reading on the subject or seek a nutritionist for maximum benefit.

This came up in my searches - http://www.doctoryourself.com/
Looks interesting , but don't have time to explore it all this morning..

This is a book, "Nourish your noggin", written by a nutritionist whose son has PCS. Has some good tips and a good general overview, but is mostly recipes.

http://www.amazon.com/Nourish-Your-N...N6Q0C1XWNHASFQ